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tv   Book TV  CSPAN  August 5, 2012 7:45pm-9:00pm EDT

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authors are here to sign books and joe allen and gary krist and >> good evening. welcome to the council on foreign relations. and laurie garrett can a senior fellow for local politics council, run the global health program, as my name tag conforms
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to. and i am very, very pleased and excited about our discussion today. we have a real treat because we not only have dr. peter piot, founder of unh, the united nations aids program, but the current director of united aids program, michel sidibe with us. a true continuity to span several decades and i think we'll have a very lively and fantastic conversation. what of course brings us here today is no time to lose, a life in pursuit of deadly viruses, peter piot's memoir. it's important to remember it's a memoir, not an attempt to write definitive history of anything, but rather an attempt to describe how the world and history to the left through the
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eyes of the key player who really put on the front lines at each individual step along the way. because it's a memoir, it's far more successful and almost a roller coaster read through an adventure cycle. and i suspect he will prove to be a recruiting device for the next generation of epidemiologists to these specialists and public health leaders because it makes it seem while, like one of the most fun things you can possibly do with your life. and many of the events that peter describes and the "no time to lose" reexperience at the same time that three different days. we both were on the frontlines watching a a new disease unfolds which later became known to be aids. in san francisco and antwerp
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both watched as the series of events unfolded that brought us to this collision course that were on now and global health. and actually of course i wrote in my first book, the coming plague, a description of the first ebola outbreak in which peter was a key player, so we'll have a chance to talk about all of these key points. what were going to do today is peter and i will have a conversation for about 20 minutes and then we'll bring michel in for a few minutes and then we'll open it up to the audience. if you have questions as it goes along, try to remember them for later on. sir peter, you were a whopping 27 years old. yet finished medical school, be sure just getting started in microbiology at the institute and antwerp.
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a mysterious test tube sample showed up in terrible condition and you figure out that there's some new disease in africa and you have the chutzpah to turn and say i'm only 27, but i want to go there. i want to go to africa. let me go. i want to be the middle of this adventure. where did all this goal come from? >> i'm actually a pretty timid and shy person. my mother always said silence this silence this, but anyways they think, but anyways i think is a bit different. first of all, i had an incredible advantage for discovery from when i was a child and when i was a teenager i worked for a travel agent who at one month to turkey and there is basically no infrastructure.
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and i think i had only one goal in life and now is to get out of my village, which was kind of a very conservative finished village. but it was a combination of defense for adventure, but also the incredible curiosity. which was the despair of my mother and my whole family because when i was like this, i always asked why we still had enough. i was the kind of kid a waste. and not to annoy people, but i really wanted to know. i also had not much respect for how yerkes and authority. so that is why he said let's go for it. let's do it. also later on, most people who have more seniority and so on in works. come and they actually were not so jump in and down to fly to
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zaire. >> they knew what a hellhole of a deep. you didn't. >> yeah, yes. i didn't. >> but coming away from the way to describe the episode, there's four things that i think are the key experiences a realization, the moments for you out of the ebola 1976 episode because this strange test tube and this 27-year-old flying to africa for the first time is, as it turns out, the ebola epidemic. the four things for first-year experience africa and fall in love with africa. second light from the discover internationalism and all the difficulty in coordinating and working together with scientists and all sorts of other folks from around the world. you discover the relationship between global inequity and
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nosocomial disease, that if people are so poor, they don't have sterile syringes they will be spread of disease. and then you discover do-gooders come that can be so badly that he would be better if they went there in the first place. so let's take each of these apart. what was it that this young flemish 27-year-old fell in love with? >> well, i think it was the warmth of people coming in now, the human side. their creativity. the music and the dancing. but the fact that it was nighttime on the one hand so much to do, the incredible names, which are still there and the will to improve. and so i saw opportunities in which i think are very
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underestimated. when you look at the growth of gdp today in the world, the highest race today are no longer in asia, but they are in africa. we see natural resources that are there. so i didn't know i'll be staying, but it is a combination of the guy feeling in the warmth of people, the human side, but also to send that i could also be very upset and angry because of the inequalities. zaire was then ruled by my boot and then there is a group of plutocrats stealing the country to death, literally. and on the other hand coming young people who are creating the recipe. there is no elect to city. so people were denied some basic
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opportunities, but i can't explain why. i was bitten by the virus in africa. >> there's a lot of dancing in the book if you haven't read it. there many times when peter is so ecstatic he breaks out dancing all over the place. this also is your first experience trying to work with american scientists. the americans came and said we're in charge, particularly carl johnson from the cdc. and you found african colleagues to collaborate with fellow belgians, typically from a little bit later after you've been there a while. tell me what she learned in 76 idg folk are about international cooperation. >> the one i discovered where i came from, that means he had us financially and technically were far inferior to what was available here in the u.s. and whereas i resented that indeed, we had isolated and then
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folks in the cdc came out were taken over, so i resented that. but then i saw that i could learn so much from someone like joe who i am still very grateful for him. there was not only the u.s., but it's like in some of these jokes, i mean, the frenchman and the south african and the bread and the belgian and american and some congolese in the plane for what happened and what do you do? that the power of coming up with some different factors. but i was very impressed by his priority in this strategic superiority of the american colleagues. so while i was there, i said i want to go to america and learn
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and just to see that next time we find a new virus and so on, i could be in charge also. it not only for myself, but just to be, you know, to share this. rather it and see an america i came back to belgium. >> is that any discovered after seeing patients bleed out the horrors that are ebola. if you haven't seen it, it's a very terrible disease, not fully for anyone to suffer before dying. particularly saddening for you, a finnish kid growing up in a time when french speakers with the dominant power structure of knowledge on in the world held down. you got in the abu cloak him in this very remote village in zaire and discovered their responsibility for it all really messed it up with fellow flemish
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catholic missionaries. tell us what that meant to you. what did you discover quite >> well, on the one hand was full of admiration for these women, particularly because the sisters were dealing with the schools and hospitals and more presiding types of activities. and they were hard-working, dedicated, but they were not one person at a formal training of nursing and there were 110 bed. and so, one of the things i learned as it's not enough of wanting to be a good time you also need basic competence. you need basic expertise, otherwise he wouldn't give injections to everyone who comes to the outpatient department where you only have three or four syringes and you need to more needles. since i was thing.
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on the other hand, i also discovered that it was like the time has stood still. so these were flemish to have -- belgian beers before and they were still thinking of the motherland as time stood still and belgium as well. they have an idea that the country of origin that doesn't respond correspond anymore. so that also reminded me of my grandmother, my ancestors. and that was something i hadn't expected. an evening like winter stews on the equator, you know? for it's very hot and very adaptive. the >> you even today are still very in touch with one of the priests coming out? >> father carlos, yes. in the congo river as it's
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called now again, with the river is about 22 millimeters wide, just incredible. he is better, but now he contacts with him by e-mail. and when i talk about this comment is still staring as if i'm coming from the stone age when it was not even cell phones, that it didn't exist satellite phones, no internet, no facebook, et cetera, et cetera. so communication is very slow to say the least. but now i'm still in touch and he's really started a secondary school. there's the hospital and so-and-so. you know, and congo, there's the notion of reality. the >> to flash forward a little bit come in the time someone took account in the pose 2000 area,
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60,000 ngos related to aids in africa allowed have been created. and when you think back to those missionaries who thought they were doing the right thing, but goodness if you don't know how to use syringes properly and basic sterile hygiene, perhaps it would be better if you are there in the first place. what lesson do you see looking forward to this explosion of ngos that can be informed by that experience? ..
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are was so interested what to move to the school even if i had said never again in academia after i left it never again in the u.n. but now here i am and because we want to train the next generation of leaders and global health. >> in 1979 you participated in an autopsy will on a belgian sailor, usa in the book i wasn't smart enough to see that it was a new syndrome, but i knew we had never seen anything like it before. and it was? >> aids. >> what was so striking just
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looking at this body before you that this is a new disease? >> it was someone that was a fisherman at the leaks in congo and the person died in disseminated microbacterial infection. we know it causes tb hand would receive it also in the environment ubiquitous white girl bacteria which don't really create any problem. probably most of us here have someone covered with. but when you are immune deficient, it can kill a jew and so we have never seen that and you just cut the muscle and there's my true bacteria you can see them under the microscope. we started seeing them in some others with infections. it's the same way that aids was
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described in this country with other infections. >> you decided that sexually transmitted diseases are acutely important and it is so interested that you adopt that as one of your major interests when almost anybody would say sexually transmitted diseases, and dhaka the feet come yuck. and this -- you come to the united states and have a bunch of training in that area particularly a the university of washington that's still there in seattle and a leader in s tds. then you go back in 1983 with some of the same people you are in the 1986 epidemic. you're in that massive --
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anybody knows what i'm talking about the massive colonial hospital, and you wrote in your diary incredible a catastrophe for africa this is what i want to work on. it will change everything. what were you looking at? >> one of my observations is dictators seem to really love their mother and the name all kind of things out there with. i'd been there in 76 and had gone through the files and here i enter men, women full young men and women in these days of my age for all kinds of these infections coming and we had 100
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cases coming from central africa belgium and that's why i went there. it was so overwhelming because i knew that it wasn't there before and also the doctor the head of the internal medicine had put aside for us like 50 files of patients that have died already in the previous month or so and this was the extent of it is the fact that it was slightly more women than men which is unusual let's not forget that in 83 it was dhaka and i never learned as to why if i reza care about the sexual orientation of its host. i saw that and i said i can't believe this must be
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heterosexual one thing i said far more heterosexual sex in the world than same-sex sacks and knowing also from my studies and sexually transmitted diseases very rampant in these days and this is going to be a catastrophe. and i was right. >> to get their view with jonathan mann and american set up protege which is an aids project the first time we met was 1985. the first international aids conference in atlanta georgia which fit in this room. >> hard to believe because the will of about 25,000 people. first i don't think we could possibly have imagined. i know i couldn't 1985 at that meeting that we were at the front end of something of a
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still be around in 2012 but by then have second or killed about 74 from 75 million human beings than in 2012 there be 34, 35 and the continent on earth we couldn't imagine that. what i remember most distinctly and at that meeting is there is a moment when this very tall white guy was translating for a much shorter fellow and a cluster of us were standing around you and "the wall street journal" reporter who was absolutely sure that hiv was a gay disease wouldn't accept the notion of general heterosexual transmission said to the doctor isn't it true that africans have sex with monkeys? and i remember this guy the trembling with rage. your face change colors coming
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yet you knew you had to translate. what was the response? well, he first pretended he didn't understand english so that gave him time to think. then he said we don't do this. but i heard about things here. islamic don't people go to see donkeys? but if you think about it, and i do want to bring michelle in a moment. but to flash forward and freeze that because your title was no time to lose. all through the book you express a sense of urgency to respond and regret that the response was not faster.
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if you look back to that critical period in the 1980's and 90's before we have effective treatment in 1996, we had many moments when interventions were blocked because of the human rights issues so we could never tackled hiv the way the we did syphilis or gonorrhea and the rationale for not doing so is there's treatment for syphilis and gonorrhea that there is no treatment for hiv so if you identify someone as hiv-positive, they will lead a life of discrimination. when you look back do you feel that there are tools and public health that we fail to embrace powerfully enough putting aside the blame to international political leaders but within the public health arena, are there things the when you look back you feel we should have done this, and the other thing before we have madison? >> we definitely lost a lot of
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time buy not recognizing it in every country when you think how president reagan or the minister couldn't simply even pronounce the word until the very end which is i'm not a psychiatrist but that means something comes of the fact that the lack of willingness to deal with the issue in the public health first dealing with aids because it was, you know, first it was in the category of sexually transmitted diseases and all of that which we stay away from these. but also later on when it came to treatment, and i know we are going to talk about tough leader but it was the public health community which was the biggest problem. they had all these reasons why it's not possible. i think there were also some of
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absurd activist demands like i was shocked in atlanta. of the whole campaign no contest is best which i didn't fully understand. on the one hand it is true that because of this discrimination and the stigma that all we could offer is all kind of negative. there is no treatment and then discrimination you lose your job and insurance and so on but i think that is retrospectively we should have had a far more conversation about what can be done but we can't see public health as a revision to and from what is going on in society. >> but we have a case example of a tremendous victory and it didn't catch on wargo firewall so to speak and there was thailand. if you look at the late-1980s the asian development bank predicted thailand was going to collapse under the pressure of aids the 17-year-old recruits
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into the military running as high as 3% at the age of 17 and at the time they were 22 in the military the rate was way beyond that and looked catastrophic and had no tools except condoms and they brought it completely under control. why didn't that become the model for the world? why we all look at thailand as if it was an isolated case? >> i think that is a good example of why they look at thailand because of strong leadership and not worrying too much about public opinion and say 100% condom promotion. it was enforced in a way not only public health people but it was of course the preserved times of the sex industry which is worth billions of dollars but
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even today d.c. an ad for condoms on prime time on tv? >> on mtv we do. >> okay, good. but it is this double standard about sexuality and sex and not wanting to deal with the issue. islamic even today it doesn't resonate. >> but it's also a problem. they are now dealing with gay men and injecting drug users and they don't want to go for the mid life change and methadone but they were very effective in the office of the prime minister it is the success and branding when your name becomes the thing >> i can't move on without
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giving you the opportunity to hit two of your most remarkable encounters. first in office was mahogany everything about it seems like he's gone to oxford and there is a gentleman sitting expensive scotch and smoking a pipe and he's telling you great paranoid conspiracy theories and you cannot make him up. who is the gentleman and what did he cost lives? >> it was a fireplace complete picture. after a very late night encounter conversation he told them don't know this is a conspiracy of the western pharmaceutical companies to poison us africans?
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it's always been a mystery why such an intelligent person who has done a lot of good things, a strategic thinker could believe such a thing. that has cost about 300,000 lives according to a study from harvard because it delayed the introduction of antiretroviral therapy of prevention of child transmission in the country, and maybe also in the neighboring countries although his colleagues even the media sometimes they were listening politely but they didn't follow him fortunately in this and not a south africa has the largest hiv treatment program in the world and things have changed. he was actually fired as president but it's a tragedy and it must be -- i don't know what it is.
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>> in a very different mood, you are with someone who it seems like today's of rahm for all the description but an ample quality of alcohol was consumed to discuss mandatory quarantine of hiv-positive people in cuba and this would be with fidel castro. >> yes. i went to cuba already in the early days for several reasons. one, there was the compulsory quarantine because cuba most of the cubans with hiv were former soldiers in the military who were fighting in africa and keen that infected with hiv and were locked up. in a conversation with fidel castro human-rights isn't something that is discussed so we talk about it has basically it's not effective. that it doesn't work.
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and today what happens in cuba is that when you are found to be hiv-positive you have to follow a six month course to prepare you for life with hiv and then many people become hiv educators sensitivity is a state employee it doesn't matter what to do. but it was -- i came there and the first time i met fidel was in the middle of some kind of tornado and he was talking about how many leaders. how many liters per square meter and so on and he's a man of figure and then after i said i came here to talk about aids and to express my solidarity with people for dead by the floods in
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cuba yes, he said coming and then he started talking about how many cases in jamaica, how many there and so on and in many ways sometimes he knew this figure is better than i do because this despite the had been a professor of has a hard time remembering these figures was of a drink in my office and i asked. i have jet lag and by the image right do my best and they said no. capito, we are in cuba. to make a long story short then we in the up and he called in half of the government and the vice president we had dinner and talk of what about all kind of things the imminent decline of
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capitalism. >> he would be dead in the second. >> the last century it still hasn't happened. >> i would like michele to join us and as she is coming up to the stage, it is interesting. do decided to go for the job of creating this new agency called the united nations aids program. it didn't even have a name and then that it's a new entity that's been to happen and they are to african colleagues that offer state at fais. kofi annan says be where the sea is full of sharks and he's not secretary general yet of the u.n. at that time. >> plus he said don't fall into the water. and if you fall into the water don't believe. [laughter] then i believe that you nsf at the time tells you the story of
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the chameleon. what was the feet come million? what was that advice? >> i was in kampala when we met at eight ch√Ęteau. >> and what was the story? >> i think the story is from when they are affecting they ask them to observe the would change color and that is not important. most important he is always walking without moving ahead so life is very important in the very clear manner.
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the second lesson is good to an objective but if you don't have a good understanding and you don't put that in perspective and your weakness you will never move. that is the second lesson. this third one is if you understood the objective you tried to never make people your target because they can moisiu wants, true, but maybe one day not miss you so it's important to really give some space for people to give you what they know so you can learn more. fourth is that you have to be in life all of that is clear be prudent. go step-by-step. of the fifth one is if he is just one second before that you
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will never change in this space. you will always of self control so in life is very important self control if not you can do all of that and messrs. objective and the last one is an adaptation. >> this is like the story of creating u.n. aids because what you've described is the entire ulin system was against you. it's almost a miracle the organization came to exist and did you describe episode after episode where either a major western donors or donor agency or a rifle when it should not have been a rifle representative if the u.n. system is sabotaging what you're trying to do. >> certainly a number of agencies he was an executive you
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gave me a hard time at the interview. >> [inaudible] [laughter] >> she said she crossed them off the list. [laughter] >> we need a microphone. >> this set are you willing to interview? okay. >> by this time i've read up on him and i'm certain i've crossed him off but i didn't in this course of the rest is history. >> when you see it was at several levels but particularly the middle management there were people like in unicef that told me if you ever come we will do everything we can to undermine
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you and make sure this doesn't happen and who was then the director-general and basically it would be to say we will just kill it etc.. it's ridiculous to even talk about. when i was writing about it i said how is this possible. to go beyond personality there is indeed an issue of the u.n. system which is very rich in terms of its diversity and agencies and everybody is looking for money. fund raising. so no, there is a lot of turf in all of that going on. and i don't think that coordination is actually the solution. but i must also say that
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probably it is the most of advanced best integrated. there is nothing that comes close as far as i can see. >> so with is all one big happy family now? >> what is difficult is what peter was talking about. we have a conflict of interest some time and people have to fight for their agenda. they have to make sure that they are relevant and make the coordination as something very difficult. but what i am seeing now is that we manage to be a little bit beyond to identify the cross cutting interest and identify the keen results areas which is making us moving into the commode and collectively saying that for example it's important to save life for people and saving life for people is to bring people at the center if we bring people and we are not talking about unicef we start
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looking at how we can create a synergy to act together. at the beginning it was not possible. they were coming from who and who was not understanding why this organization had been created and each organization was fighting to create their own identity so his job was a very tough one. islamic what i of seen as the u.n. system is at its best around the very concrete outcome than it can move mountains and if it concentrates on the process as is often the case particularly here in new york then it is a waste of time for everybody. so that is i think my conclusion for the director of unicef and your body language tells me that
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you agree. [laughter] >> today at this moment, though she 20 leaders were probably drinking tequila and had a day of accomplishing very little. also at this moment they are probably drinking rum at the rio plus 20 and there's very little optimism for that meeting. we are in a moment everything seems to pass it on the euro crisis. the amount of money on the table keeps shrinking. the sense of generosity is shrinking and we hit seen since 2008 with a financial crisis ever greater dependency on one source, united states government which i think is now about 60% of support for international hiv efforts. what does this mean for you in
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terms of trying to coordinate aid in response? >> he said something important the world is changing. ten years ago when we were talking about the millennium development goals [inaudible] six, 7% even though growth rate like we that 15%, 11%. we are not talking about china, brazil and others as key players in the new global government systems. for me but is important today is what we're trying to push on the shared responsibility. we cannot use the whole paradigm what we are trying to push is to bring different players.
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we've been able to work with the chinese and if they are now paying for their own response which is very important on the global fund. they've been working with india and they decided to pay for all of their response so we're seeing south africa increased to $1.5 billion. so we are seeing the world coming in this response in a different way and we need to push that and make sure that of course it will be on social justice opportunities that is critical because it's what we want people to make it. they told me that it is $72,000. how can that happen if we have 9 million people waiting for treatment in africa we need to
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change so i am seeing that new movement come and which is important and that is built on what peter did. he was my boss and his one of the best we probably have and he cannot share what he has been able to do for the world because today if we save millions of lives. i want to say that. we weren't aware two-year de katella years ago looking countries by countries why it is not working. today we have almost 7 million people on treatment. peter moved us from the millions to billions in terms of organization demonstrating the solidarity and collective was
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indispensable to save lives for people and i want to say thanks to peter and i am building on that. >> but when you look at the index of this book it's only people and that's on purpose. why? anything that was a growing going were wrong was personal force and this was a movement and there were so many people contributing and all equally important, but what's important also is that making sure it is in the bronx and movement which sometimes it looks like going into all directions and trying to align the stars. the politics and the signs and the programs on the ground are in harmony or supporting each other and that is going to be very important. now, it's not normal that the
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global fund for years funded programs and argentina, and mexico, in chile and china and so on and that is denying money and according to our projections the we did by 2030 after the beginning of the eight epidemics would require 4% or more of its gdp just on treatment cost. estimate that if we don't have to go to third line therapy. islamic there is no way on earth that can be done without international help. they have a budget so for a smaller use of our resources in these days.
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i wanted very quick answers we have time for the audience and that is we are about to have the international aids conference in the united states for the first time since 1990 in washington, d.c.. next month when we are in the most hotly contested presidential election will give seen and i don't know how long this moment most experts say you can't call who will be the next president of the united states. when the last time the aids community convened in washington, d.c. they denounce the vice president george bush during the ronald reagan presidency and angered him so much that when he took over as president he said i don't want to hear about this. get out of the room. if there is one message that the american people take from this upcoming conference and you have the ability to wave a magic wand
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and make it happen as opposed to other scenarios and come what may happen, what with that message be? >> i am just coming from a listening to our. i want to say that it would be missed opportunity to not say that the individual and collective effort were saved the life of a million of people and that is not to please them it is to return this cross party effort because we have a sense of urgency it has been completely changing all of our response and then with what president obama brought by the
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debate on the shared responsibility looking at the sustainability of ownership or just the movement we need to share and i hope this message we would be able to operate because american people individually need to hear the rest in saving the lives of millions of people and we are making the effort to share with other countries now and that should be the message. >> along the same lines i would say tax payers' money has saved millions of lives and has also i think in proved that the american image in the world to a large extent. a decrease in that effort now is not going to cost millions of lives because people will die but also i think would be stupid
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from a perspective of smart foreign policy. now let's see how our friends -- the biggest problem of the conference i think may be how do the american aids activists handle that? that is i think the biggest challenge. >> that is a good note to take questions from the audience. i would ask that you raise your hand and wait until the microphone reaches you and please be sure to identify yourself and give a real question. i see one right down here if we can come down the front. robert martin from rockefeller foundation. >> thank you. >> would you stand? >> sure. thank you for the book. i flip through it in a few days and i would agree it is definitely going to inspire the next generation and following on that, my first question is what advice do you have for the next
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generation of global public health leaders and then the second question is at one point in the book i think it is towards the end when you are leaving you have something like an oscar schindler moment you think i could have done more or i could have done differently. the question is if you could go back and redo the last ten or 15 years, what would you do differently if anything? >> the first advice one is that the world is becoming very global so there is a great future i think in working in global health. don't plan your career in detail because he will miss then the great opportunities to that i think i certainly didn't imagine that i would ever be a bureaucrat but be prepared this
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is my old boy scout time. be prepared and investing your training and skills and all bassett you can see is these opportunities. there are many open doors that are there that people don't go through them even if you don't know so take some risks. what have been done differently? i think probably politicize aids faster in the sense. when i started in u.n. aids i was quite naive thinking if we had the evidence and the facts and so long this is great change everything. of course but was not the case so i should have brought it earlier to that big political agenda but maybe it was not possible. i think that is probably the biggest -- i don't know. i still wonder if i could have
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accelerated things. on the one hand i have no patience for things in on the affair and we have to go through certain things. i really don't know. i wish i knew. >> stand up, please. >> i always tell people i am standing that is the story as a child. [laughter] a question for both gerient meshaal and peter. in my recent troubles working with fantastic people from the cdc and elsewhere fighting this battle you get the sense that we are at a turning point. i don't know if it is a tipping point that the concept of an aids fried generation and viral suppression and getting signs of encouragement that in fact the end point if you will could be in sight for the first time making this a critical time to
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ensure that momentum is not lost. first question would you agree with that characterization and second what could help drive that momentum forward and what could risk it? >> i think this is a triggered planned and you know my optimism for me to get into zero is a vision. of course it means nothing but it is a vision for making society more inclusive taking the decision to say we don't discriminate people based on their race or sexual orientation or their social studies it is our position and we can get and i am seeing progress every single place. when i decided to push for this
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by 2014 and i'm supporting very strongly by 2015 we don't need to have babies born with hiv. people are saying it is a dream from where will we get that? today we are seeing that. i will share this number with you but from last year to this year it's decreased by 100,000. 100,000 of the numbers of babies born by hiv last year compared to this year. we are seeing also an increase in numbers of people living in this crisis we see the new momentum showing clearly if we put people on treatment we can reduce by 96% so for me i am seeing hope. i want to push for the ideas of getting to zero.
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knowing that would be multiple zeros but we can be there if we raise different constituencies and for me it is time to bring this approach because it would be missed opportunity if we don't do that. >> i agree with the vision because we cannot accept anything less. we need to be prepared for decades of investments and continue to use was starting with people who are now on antiretroviral therapy. we hope that that will last and be effective for decades of normal life expectancy so we need to be prepared for that. and i think we are not prepared for that. >> we are seeing a rising tide of drug resistance already. >> drug resistance. buying new drugs is going up and genetic manufactures are pulling out because the prices have
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become so low they don't make a profit and they're moving for drugs to diabetes and heart cardiovascular disease and the need may have been greater in terms of units that can be sold. also in terms of prevention. so i think we need to have an ambitious vision but also we need to be prepared for this longer-term. but i agree there is kind of a momentum where we see a return of the investments in the past decade basically because these don't happen overnight. >> i think we need to be able to manage the response with the perspective on the long term but what we need now is to change our way to deal with innovation with the type of innovation we have today we will not be a will to scale up. is it possible for me to believe
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that you will go to 15, 20 million people in africa if you have to have reform everywhere and if you -- so the simplification. like i said in my letter to the partners the green pellicano yellow bill and redpoll will simplify every day and looking at how we bring it is helping us now to look at how we simplify. if we don't simplify its not possible. today let me give you one example. with the reform just to make sure that we have the 9 million people who are waiting for the treatment would cost that $700 million most are not working in that difficult. so i was in the burma institute in australia and milbourne and
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they are testing this today in malawi. they can take their blood and two minutes later they can tell you if it is 350 or below 350. so for me i'm looking for this type of innovation to shift the task force can be done by a low were educated people and we interface between the service provider community. >> i should clarify for the full audience they are a type of cell in the human immune system that are very specifically targeted by the hiv virus. so as the account goes down you are clearly heading towards a six stage of the disease. i think we have time for at
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least one more question. i think i saw the family care international back there. >> line from a family care international and i wanted to ask if you could comment specifically on what you see as the priorities and the trends and possibilities in sub-saharan africa which is the region where the problem of hiv/aids is most secure in terms of population and in particular looking at it from the perspective of this long term potential and the question of what is the more strategic approach in terms of dealing with hiv/aids as more less of a vertical issue or integrating it with the provision of basic health services and child health services looking at the issue coming down. when you see is the most appropriate for dealing with this and africa. >> iowa think i build on what
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peter did when we were working together when he started to demonstrate it is an exceptional disease and it was important to bring that in the political agenda but since then i tried to take it out and singing that is not possible to deal with aids anymore is karma. we have this section you're talking about hiv health. if you take africa the major challenge we have is women, women. the issue of violence against women and issues of positioning of women and making sure that they can get other information on their health was so we can have less younger girls being
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unnecessarily pregnant and going in for an unsafe abortion and others. that is one priority. the second one will be certainly human rights. of the human rights issues making sure people that were not a part of the mainstream society and how we address so they have access to services and their sexual orientation and me it's still education to make sure that young people are equipped with the skills and i will go for those were were as a major challenge and others need to be
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there in the social change which we need to address. >> peter, the final word. >> i think also there are many africans so it is quite important that we customize what we do to each society. and that is something that is a big challenge for any global movement. we tend to have a bunch of experts come together and that's good. that's the package and that is good for everybody. frankly that is and how the world functions and that is and how any customer oriented company works, so we need also the analysis of the situation and then what provided the menu also what you mentioned these are generic issues that have to be applied. let's take southern africa. we still have incredible incidence to cut three, 4% per
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year of young women became hiv positive. there's nothing more important when you are in west africa hiv prevalence is lower than in new york city and you need to fully integrate and do it in a different way. that is also a lesson in humility for the global community. >> welcome i want to thank peter for writing a time to lose and thank michelle and peter for joining the council on foreign relations today. thank you very much. [applause] >> the reception is downstairs.
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>> the official seal of the end of louisville kentucky reflects its history and heritage. they represent french aid given during the revolutionary war and the 13 stars signify the original colonies to read book tv brings you john david next. the leader takes a look at the political career of senator mitch mcconnell who served as senator of kentucky since 1985. >> the senior senator from kentucky he is the longest serving senator from kentucky and the republican leader in the united states senate and some contended the four most republican in history. he was born in alabama, came to kentucky as a young person, got involved in republican politics, served as the county judge
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executives here in jefferson county which is the large city in kentucky is located and ran for the senate in 1984 and ousted the democratic incumbent and has been reelected four times since then. it's been a steady upward decline in the ranks of republican leadership in the u.s. sent. he came in with no connections and no national reputation and kind of built his reputation on issues like campaign finance reform and resisting a lot of the measures in campaign finance reform, got into the leadership and now is the leader and would aspire to become the senate majority leader after the election this fall. his primary legislative area of expertise is probably campaign finance reform. he's still active and filing briefs and litigation in the supreme court opposing campaign finance reform that he thinks would infringe upon the first
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amendment but he has also done several other things. he is renowned as the foremost advocate for burma in the united states and long before the issue in burmese reform became widely known come he's been toiling in that vineyard for many years and in fact he recently went to burma it should to meet with the nobel laureate. he had a measure to protect space instutions in hong kong. during the bush administration he was involved the national security, national security wiretaps etc.. he is a very soft-spoken person. a big university of louisville sports fan. he reads a lot history and he does his own grocery shopping
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and is often telling stories of people he meets while shopping for the groceries and i think that is one of the ways he tries to keep in touch and avoid becoming a politician who is washington rather than louisville. he does try to come home and stay in touch with of a constituent spoke at the ball games and doing things like his grocery shopping. he's pleasant, he doesn't manifest much of a temper. but that doesn't mean that sometimes he doesn't get upset with folks. i think his reputation is that of being a very canny very clever political operator. he is thought to be a master parliamentarian. in fact he built his reputation largely on coming up with legislative strategies using parliamentary tactics, and he is thought to be a hardball political player but i think
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senators will also say his word is his bond he is someone you can make a deal with and once you have, it will stick. i think the democrats here and kentucky described the begrudging respect. they obviously disagree with him a lot and they think he is ruthless probably in some respects. but they also admire what he has done to build the republican organization in this state. it was and still is a predominantly democratic state but mcconnell while making his way upward in the republican senate leadership has also helped build a much stronger effective republican party here in the state. you can't describe him as a beloved figure buy any means but i think you can describe him as a widely respected figure. he's been elected five times. he's done it with a bipartisan
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support and in this space state the people of kentucky appreciate someone in leadership and it's been a long time since a kentucky in had been prominent u.s. senate leadership. they like that. he brought back a lot of things to kentucky and i think every local community can point to something and say mitch mcconnell had a role in helping us get that and he's also been flexible. mcconnell hasn't just been an ideologue who won't move for change with the times. he house basically mirror where the republican party has been. george will describe him as thoroughly marinated in the institutions of the senate. he is a creature of the senate and the only other position that i thought he might be well suited for is secretary of state at some point but unlike a lot of senators she's never really wanted to be president and
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that's been very much of a factor in his success in the republican senate leadership. he's always been a creature of that chamber and has never really thought he was a president when he looked in the mirror in the morning. i worked on the book for about five years, interviewed countless people that no senator mcconnell had a lot of interviews with him. i had met him before but we were not by any means close acquaintances and i probably would not have done the but if he had been unwilling to cooperate. the book is not an official biography, but the senator did cooperate with me. sometimes i would share with him something i was thinking of writing and he would offer his opinion as to where he thought that might be wrong but i thought to his great credit she would always say it's your book
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and i am not trying to tell you what to write but here is my take on it. sometimes i thought he had a good plate and i would modify what i had that there are parts that remain in the book that he doesn't agree with i would have to say. for example, whether president ronald reagan had coattails' that helped senator mcconnell and his 1984 reelection, senator mcconnell this piece that but i happen to think that there is something to with that. there are some criticisms in the book. some stands he took on various pieces of legislation that i sure he would dispute. the medicare prescription drug benefit that was passed during the bush administration is an example of where the perspectives are somewhat different. but as i say in the book, for the most part, i am in agreement with the mcconnell political
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philosophy. there are instances in which we part company. also, i was just very impressed with how this person who came from another state was not a kentucky native and kentucky can be a very provincial state. it's not easy sometimes for outsiders to make their way and have done all this and his discipline and tactical thinking intrigued me. >> for information on this and other cities visited by the sec and local content of vehicles, visit c-span.org/localcontent. what are you reading this summer? book tv once to know. >> so much to read in this busy summer for the presidential election. i'm still reading the terrific new edition of the biography of lyndon johnson passage of power. also going to read something else from that era. mark's

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